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Royal Brisbane and Women's Hospital COVID-19 Response Plan€¦ · particular outline the response plan for Royal Brisbane and Women’s Hospital (RBWH) . The strategic objectives

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Page 1: Royal Brisbane and Women's Hospital COVID-19 Response Plan€¦ · particular outline the response plan for Royal Brisbane and Women’s Hospital (RBWH) . The strategic objectives

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RBWH Hospital COVID-19 Response Plan 2 September 2020

Page 2: Royal Brisbane and Women's Hospital COVID-19 Response Plan€¦ · particular outline the response plan for Royal Brisbane and Women’s Hospital (RBWH) . The strategic objectives

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Published by the State of Queensland (Metro North Hospital and Health Service), August 2020

This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au

© State of Queensland (Metro North Hospital and Health Service) 2020

You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Metro North Hospital and Health Service).

For more information, contact:

Metro North Emergency Management and Business Continuity, Metro North Hospital and Health Service, Block 7, RBWH, Herston QLD 4029, email [email protected], phone 07 3646 3743.

Disclaimer:

The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information.

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Contents 1 Introduction ............................................................................................................................................ 5

2 Pandemic phases ................................................................................................................................... 7

3 Overview of RBWH and infrastructure ................................................................................................ 7

4 Partners and stakeholders .................................................................................................................... 8

5 Roles and Responsibilities ................................................................................................................... 9

6 Activation ................................................................................................................................................ 9

7 Response .............................................................................................................................................. 10 7.1 Tier 0: Prevent local transmission and prepare ..................................................................................... 10 7.2 Tier 1: Limited community transmission ................................................................................................ 12 7.3 Tier 2: Moderate community transmission ............................................................................................. 14 7.4 Tier 3: Moderate community transmission ............................................................................................. 15 7.5 Clinical management for suspected, Probable or confirmed COVID-19 positive patient ...................... 16 7.5.2 Resource management .......................................................................................................................... 21 7.6 Human resources ................................................................................................................................... 22 7.7 Aboriginal and Torres Strait Islander people ......................................................................................... 25 7.8 Vulnerable groups .................................................................................................................................. 26 7.8.1 People with Mental illness ...................................................................................................................... 26 7.8.2 People with disabilities ........................................................................................................................... 27 7.8.3 Residential aged care residents ............................................................................................................ 27 7.9 Financial management ........................................................................................................................... 27 7.9.1 Medicare ineligible patients .................................................................................................................... 27 7.9.2 Activity capture ....................................................................................................................................... 28 7.10 Private Hospitals .................................................................................................................................... 29

8 Control .................................................................................................................................................. 29

9 Recover ................................................................................................................................................. 30

Appendix 1: RBWH COVID-19 Committee list .................................................................................................. 31

Appendix 2: Infrastructure at Tier level ............................................................................................................ 31

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Abbreviations AEFI Adverse Events Following Immunisation

AHPCC Australian Health Protection Principle Committee

BAU Business as Usual

CC&CSS Critical Care and Clinical Support Services

CCS Cancer Care Services

CE Chief Executive, Metro North Hospital and Health Service

CHO Chief Health Officer

COH Community and Oral Health

DDCC District Disaster Coordination Centre (Queensland Police Service)

DDMG District Disaster Management Group

DMI Department of Medical Imaging

EMP Emergency Management Plan

EOC Emergency Operations Centre

ERP Emergency Response Plan

GP General Practitioners

HC Hospital Commander

HEOC Metro North Hospital and Health Service Emergency Operations Centre

HIC Health Incident Controller

HIU Health Improvement Unit

HLO Health Liaison Officer

IAP Incident Action Plan

ICT Information and Communication Technology

ICU Intensive Care Unit

ILI Influenza-like Illness

IMS Incident Management System, Internal Medicine Service

IMT Incident Management Team

LDMG Local Disaster Management Group

MN Metro North

MN – EMC Metro North Emergency Management Committee

MN – EMP Metro North Hospital and Health Service Emergency Management Plan

MN – EMU Metro North Emergency Management Unit

MN – ERP Metro North Hospital and Health Service Emergency Response Plan

MN – IMT Metro North Hospital and Health Service Incident Management Team

MNHHS Metro North Hospital and Health Service

MNPHU Metro North Public Health Unit

MOU Memorandum of Understanding

NDIS National Disability Insurance Scheme

NDRRA Natural Disaster Relief and Recovery Arrangements

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AEFI Adverse Events Following Immunisation

NMS National Medical Stockpile

PACH Patient Access and Coordination Hub

PCR Polymerase chain reaction

PPE Personal Protective Equipment

QAS Queensland Ambulance Service

QDMA Queensland Disaster Management Arrangements

QHIMS Queensland Health Incident Management System

RBWH Royal Brisbane and Women’s Hospital

SET Senior Executive Team (Metro North Hospital and Health Service)

SHECC State Health Emergency Coordination Centre

SITREP Situation Report

SMEAC Situation, Mission, Execution, Administration, Communication

SPOS Surgical and Perioperative Services

TPCH The Prince Charles Hospital

WNS Women’s and Newborn Services

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1 Introduction 1.1 Situation In December 2019, China reported cases of viral pneumonia caused by a previously unknown pathogen that emerged in Wuhan, China. The pathogen was identified as a novel (new) coronavirus (recently named Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)), which is closely related genetically to the virus that caused the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS). SAR-CoV-2 causes the illness now known as Coronavirus disease (COVID-19). Currently, there is no specific treatment, vaccine or antiviral against this new virus.

1.2 Purpose The purpose of this pandemic response plan is to ensure continuity of health services and minimise the community impact within Metro North Hospital and Health Service (Metro North HHS) of COVID-19 and outline the response plan for Royal Brisbane and Women’s Hospital (RBWH).

The strategic objectives of this plan are to:

• Minimise risk to staff responding to COVID-19 through appropriate training, Personal Protective Equipment (PPE) and infection control practices

• Minimise the transmission of COVID-19 within the Metro North HHS community and within healthcare settings through proactive identification and testing, effective infection control activities, and community messaging

• Determine appropriate measures to increase capacity to meet demand during the pandemic

• Ensure the HHS maintains its critical services continuity

• Maximise health outcomes for people with COVID-19.

NOTE: This plan is a working document and will be revised as processes are changed or information becomes available.

1.3 Authority Nationally, the Biosecurity Act 2015 and the National Health Security Act 2007 authorises activities to prevent the introduction and spread of diseases in Australia and the exchange of public health surveillance information (including personal information) between state and territory government, the Australian Government and the World Health Organisation (WHO). The WHO declared the outbreak of COVID-19 a Public Health Emergency of International Concern on 30 January 2020.

The Queensland Department of Health declared a public health event of state significance under the Public Health Act 2005 on 22 February 2020. Public Health Agreements are issued by designated Emergency Officers (Environmental Health Officers) under this act. The issuance of a Detention Order by an Emergency Officer (Medical) (Public Health Physicians) is also under this Act.

The Chief Health Officer (CHO) directed all health services to:

• Provide health staff to screen and conduct clinical assessment of passengers identified by Australian Border Force including the transfer of symptomatic persons to emergency departments for testing / treatment and / or supporting access to government provided accommodation where travellers are identified as not being able to isolate in the same location for 14 days.

• Via Public Health Units:

– Issue isolation agreements to travellers at points of entry who meet COVID-19 case definition; suspect case definition or close contact case definition

– Provide information and guidance to general practitioners and the public regarding testing and isolation requirements

– Contact trace any persons who may have been in contact with confirmed cases

– Support the clinical management of persons who are in isolation

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• Plan for new or expanded models of care (such as telehealth / Hospital In The Home (HITH), virtual wards and treatment of chronic conditions at home).

The Queensland Government declaration of a disaster situation was activated on 22 March 2020 and remains active.

The COVID-19 response within Metro North HHS is authorised by the Health Incident Controller (HIC) under the Metro North Emergency Management Plan. Each Directorate within Metro North HHS is required to develop their own individual pandemic response plan.

1.4 Scope This pandemic response plan covers the Royal Brisbane and Women’s Hospital (RBWH) response to COVID-19 to ensure the continued delivery of critical clinical services to existing patients, the Metro North HHS community and other health services where requested for assistance has been received and accepted and should be read in consultation with the RBWH Emergency and Disaster Response Plan. This plan is supplementary to the Metro North HHS COVID-19 Response Plan which is updated regularly and provides details on state and federal government policy decisions impacting service provision.

Key information has been included in this document however there are a number of Service Line or Unit subplans that sit underneath this. These subplans are:

• RBWH Department of Medical Imaging

• RBWH Pharmacy

• RBWH Internal Medicine Services

• Transplant services

• Kidney capacity

• RBWH Intensive Care Unit

• RBWH Emergency and Trauma Centre

• Cancer Care Services (CCS)

• Surgical and Perioperative Services Outpatient Department

• Women’s and Newborn Services (WNS)

• Operating Theatre

• Specialist Outpatient Services

• Mental Health Directorate

• Allied Health Services

1.5 Assumptions This plan was developed based on the following assumptions:

• The incubation period of COVID-19 is up to 14 days (in line with current WHO advice)

• Routes of transmission is via large droplet or fomite route

• Telecommunication networks (or adequate redundancies) are operating

• The Queensland Health Information Communication Technology (ICT) Network remains operational

• Support services (e.g. Australian Red Cross Blood Bank, eHealth, Health Support Queensland (HSQ) (including linen and central pharmacy), Queensland Urban Utilities, Unity Water and ENERGEX) remain available albeit at potential reduced capacity.

• There will be impacts to Metro North HHS staffing.

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2 Pandemic phases Australian phase Description

ALERT OS3

A novel virus with pandemic potential causes severe disease in humans who have had contact with infected animals. There is no effective transmission between humans. Novel virus has not arrived in Australia.

DELAY OS4/OS5/OS6

Novel virus has not arrived in Australia OS4 Small cluster of cases in one country overseas. OS5 Large cluster(s) of cases in only one or two countries overseas. OS6 Large cluster(s) of cases in more than two countries overseas.

CONTAIN AUS 6a - January 2020

Pandemic virus has arrived in Australia causing small number of cases and/or small number of clusters

SUSTAIN AUS 6b – 25 March 2020

Pandemic virus is established in Australia and spreading in the community

CONTROL AUS 6c Customised pandemic vaccine widely available and is beginning to bring the pandemic under control.

RECOVER AUS 6d Pandemic controlled in Australia, but further waves may occur if the virus drifts and/or is re-imported into Australia

Note 2008 Australian Phases version used over 2019

3 Overview of RBWH and infrastructure The RBWH catchment has a large metropolitan hospital with approximately 879 beds located at Herston, 7 kilometres north of the Brisbane Central Business District (CBD). The RBWH is the largest hospital in the Metro North Hospital and Health Service.

There are 123 general practices in the RBWH catchment including 586 general practitioners. This represents 171 general practitioners per 100,000 people. There are total of 2,000 residential aged care places in the catchment representing 53 residential aged care places per 1,000 people over the age of 65.

There are 14 private hospitals in the catchment, 4 with overnight beds and 10 with day surgery facilities.

Overnight beds Day surgery facilities

• Brisbane Private Hospital • Eye-Tech Day Surgeries

• Peninsula Private Hospital • Marie Stopes Australia Bowen Hills Day Surgery

• St Andrew's War Memorial Hospital • Montserrat Day Hospitals (Indooroopilly)

• The Wesley Hospital • Pacific Day Surgery Centre

• Queensland Eye Hospital

• Rivercity Private Hospital

• Samford Road Day Hospital

• Spring Hill Clinic

• Spring Hill Specialist Day Hospital

• Westside Private Hospital

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3.1 RBWH infrastructure The following provides an overview of baseline available infrastructure for RBWH.

Locations identified Number/Capacity

Total acute capacity • 834

Emergency and Trauma Centre (ETC) treatment spaces

Building 41, Ground level • 47

Intensive Care Unit (ICU) Building 41, Level 4 • 36 beds

Fever Clinic ETC & Ambulance Bay • 10 per hour

Isolation Ward Building 39, Level 6 • 16 Wattlebrae Ward

Isolation Rooms • 113 Isolation rooms + • 5C – Haematology has 17 and Cancer

Care has 6

Crash Trolley Multiple clinical areas • 77

Oxygen outlet points Multiple in all clinical areas • Block 39 – Joyce Tweddell Building – 182 Outlets

• Block 40 – Ned Hanlon Building • Block 41 – Joyce Tweddell Building

Dialysis Machines Building 40, Level 9 ICU 8BW Moreton Bay Integrated Care Level 1 Northlakes Health Precinct Stafford Kidney Health

Dialysis Machines • 23 in use 5 back up + 2 portable ROs • 2 • Plumbed 6 beds • 14 in use 4 back up 1 portable RO • 12 on floor 2 back up 1 RO • 8

Mortuary Building 40, Level 2 • 19 Adult spaces • 17 Baby Spaces • Cold Room type

4 Partners and stakeholders RBWH Directorate has a range of local partners and stakeholders who RBWH will work with in order to deliver on this response plan and continue to provide high level healthcare to the local community. These partners and stakeholder include:

Metro North Hospital and Health Service (MNHHS) Board MNHHS Public Health 

MNHHS Streams NeoResQ

RBWH Clinical Council RBWH Foundation

General Practitioners  Community Pharmacies 

Queensland Ambulance Service   Private Hospitals 

Non-government organisations (NGO) Academic and university partners

Commercial car parking operators Ronald McDonald House

Queensland Police Service (QPS) liaison service QPharm

Queensland Fire and Emergency Services Retrieval Services

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5 Roles and Responsibilities In line with the Queensland Health Pandemic Plan, the Department of Health leads the overall response to pandemic within Queensland and will coordinate and direct response requirements at a system level. Metro North HHS will coordinate and lead the implementation of response requirements at an HHS level and will support Directorates. RBWH will work within this framework and deliver a facility response and frontline services to Queenslanders.

6 Activation Metro North HHS activated the Metro North Emergency Management Plan and the Health Emergency Operations Centre. The RBWH scaled up a response from early February from initial planning with key stakeholders. The fever clinic was established to formally standing up an Incident Management Team on 9 March and activating an expanded Emergency Operations Centre on 23 March 2020.

6.1 Command The Hospital Commander for RBWH has been delegated by the Executive Director to the Director Medical Services.

COVID-19 related questions, queries or concerns are to be escalated through service lines / directorates / or streams to the RBWH IMT for decision.

6.2 Communication All incident communication is to be via RBWH EOC account [email protected] and Metro North EOC account, [email protected].

RBWH IMT provides an internal Situational Report (Sitrep) to service lines, directorates, streams and the Metro North HEOC when changes occur.

Consistent staff communication is critical using multi modes, including online platforms, MicrosoftTeams, staff forums, Vidcasts and Marketing and Communication messaging.

Communication directed to patients and visitors is escalated to the RBWH IMT to be approved by the MN IMT. Information will only be disseminated by MN.

Signage requests to be directed to the RBWH IMT.

6.3 Reporting RBWH is required to report on admitted positive, suspected / probable fever clinic, intubated and ventilated patient numbers to Metro North HEOC. The timing of reports is based on the current level of response required.

Other reporting requirements will be managed by the RBWH IMT as they come in.

Service lines, directorates and streams will be asked to contribute to reporting where required.

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7 Response The RBWH COVID Response Plan considers the response from Tier 0 to Tier 3. Tier 4 and 5 are considered at a whole-of-HHS level.

7.1 Tier 0: Prevent local transmission and prepare Governance Personnel Fever Clinic ICU

IMT RBWH EOC Stood up

Staff /workforce management (presenteeism and absenteeism)

Upskilling workforce to manage COVID-19 positive patients

Adjacent or external to ETC, – adjust capacity based on demand

Maintain as is Utilise 4 single rooms for

COVID-19 confirmed, probable and suspected patients

MERT responsibilities – ICU nursing staff as first responders with support from ICU medical as requested

ED Inpatient COVID-19

Dedicated Respiratory area in ETC for patients with ILI symptoms.

Single rooms, isolate suspected/probable/confirmed COVID-19 patients or those in quarantine

Minimise movement of inpatients with confirmed/probable or suspected COVID-19 within wards or across the hospital, use portable x-rays and ultrasounds where able.

All blood collection and ancillary services managed within the ward

SUSTAIN -TIER1

SUSTAIN -TIER 0

SUSTAIN -TIER 2

SUSTAIN -TIER 3

SUSTAIN - TIER 4

SUSTAIN - TIER 5

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Probable and Confirmed Patients to be managed in Wattlebrae (16) + 8BS (or identified COVID ward (20)

Birth suite – capacity for 1 COVID-19 confirmed patient

Meetings Training Service Operations Facility

Adhere to social distancing Virtual meetings where able RBWH IMT summary teleconference

– daily Mon - Fri MNHHS IMT teleconference – as

scheduled by MNHEOC

No restrictions – social distancing to be observed

PPE training for all staff Establish PAPR protocols, cleaning

and training

Implement hypervigilant screening/ testing

All non-urgent review appointments to be done virtually.

Consider patients wearing masks for OPD clinics where social distancing is not possible

Increase procedural and outpatient clinic activity including extended hours and Saturday sessions – maximise category 1 and 2, focus on category 3 waiting longer than 240 days and current long waits.

Utilise flexible theatre templates Outsource activity where appropriate Outpatients supplied with one month

of medication. Outreach services to continue

Signage at entrances alerting patients, visitors and staff not to enter a health service if unwell

Entrances/Exits – separate staff entrances, sanitising stations at all entrance

Concierge at key entrances Fast track all patients with ILI

symptoms to Fever Clinic or ETC Triage

Security – maintain PPE - Facility centralised order

form and collection room Daily teleconference including in and out report (7/7)

Cleaning - frequent touch point cleaning

Pharmacy – maintain 6 months’ supply of pharmacy stocks (based on usual supply)

Consider allocation of CT scanner for suspected, probable or confirmed COVID-19 patients

Food, linen and waste services use PPE in accordance with

Queensland Health Pandemic Response Guidance, personal protective equipment in Healthcare delivery document.

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7.2 Tier 1: Limited community transmission

Governance Personnel Fever Clinic ICU

As per Tier 0 plus: PPE stocktake - if stocktake variance

exceeds 5% (of prior day’s closing balance) for three consecutive weeks, change to daily stocktake

As per Tier 0 As per Tier 0 - Adjacent or external to ETC, – adjust capacity based on demand

Commissioned beds (36) Where clinically appropriate,

defer complex elective surgery requiring post ICU management

Open additional non-commissioned ICU bed spaces (1-3)

ED Inpatient COVID-19

As per Tier 0 - Dedicated Respiratory area in ETC for patients with ILI symptoms.

As per tier 0 plus: 6AS Cryopreservation of all

donors prior to planned BMT 6BN Implement hospital avoidance strategies for non-urgent antenatal care. Increase gynaecology surgery lists for cat 1 Convert Rm 5 into an overflow ICN/SCN

Meetings Training Service Operations Facility

As per Tier 0 As per Tier 0 As per Tier 0 plus: Increase use virtual models for

outreach services where able Consider patients wearing level 1

surgical masks for OPD clinics where social distancing is not possible

Maintain activity and critical referrals in from other HHSs.

Prepare processes to enable suspension of Category 3 and 6 elective surgery, medical and non-emergency dental procedural activity when advised.

As per tier 0 plus: Security – maintain Cleaning - frequent touch point

cleaning plus increase yellow clean teams

PPE - 3 per week stocktake Students only allowed to wear for direct patient care, not for observational purposes Daily PPE teleconference Facility centralised order form and collection room Weekly stocktake 3 per week teleconference

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Prepare for cessation of non-urgent category 2 surgery. (NOTE: suspension of activity not to occur without authorisation from the Chief Executive).

Reduction in outpatient appointments (Cease Cat 3, 2 and some entire services)

Pharmacy - Daily hand sanitiser stocktake increase hours of operation as required Outsource dispensing where appropriate Redeployment of staff where needed

Prepare processes to enable suspension of accepting Category 3 OPD referrals when advised. NOTE: suspension of activity not to occur without authorisation from the Chief Executive.

Cancer Care Screening of patients occurring at

admissions desk in OPD Outpatient maternity

Change all bookings to check in online Cancel childbirth education sessions Reinstate weekend clinics Diabetic and hypertensive women to be managed remotely

Daily in and out report (M-F) Fortnightly meeting with procurement Weekly call with HSQ Weekly internal audit

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7.3 Tier 2: Moderate community transmission

Governance Personnel Fever Clinic ICU

As per Tier 1 Identification of processes for vulnerable staff and work from home arrangement – NOTE: not to occur without authorisation from the Chief Executive.

Consideration of redeployment of staff to areas with higher activity in this phase e.g. Fever Clinic, Concierge, Staff entrances

Maintain Tier 0 capability plus: Increase staffing to fever clinic to

increase throughput Increase equipment to increase

throughput

Additional beds within ICU (between bays) (54) • Where clinically appropriate, defer

complex elective surgery requiring post HDU / ICU management.

• Expand ICU capacity within build environment.

• Identify potential additional capacity for ICU ventilated beds in alternative clinical areas

ED Inpatient COVID-19

As per Tier 0 - Dedicated Respiratory area in ETC for patients with ILI symptoms.

As per Tier 1 plus: Consider use of 8BS (20), 8BW

(18)

Meetings Training Service Operations Facility

As per tier 0 plus: Consider cancelling non-essential

meetings

Cancel non-essential training Essential training via online platforms

where possible – social distancing to be observed

PPE training for all staff Establish PAPR protocols, cleaning

and training Upskilling workforce to manage

COVID positive patients

As per Tier 1 plus: • Consider activation of decanting

established COVID-19 wards • ↑ application of PPE across clinical

and nonclinical areas in line with MNHHS direction

• Consider the establishment of COVID-19 medical teams

• Consider ward based over team based medical care

Surgery: • Category 1 and 4 and urgent

category 2 and 5 only when directed by CE

• Category 1 elective – life and limb saving surgery only

As per tier 1 plus: • Facility restricted access and

visitor exemption process Concierge – as Per Tier 0 Plus: • Increase staffing to concierge

and staff entrances to manage restrictions and access to facility

• PPE: Daily mask & visors count

• All staff and patients require face masks

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• Category 1 elective surgery only on directive from MNHHS

Outpatient maternity As per Tier 1 Progress to online education sessions

Pharmacy – • consider ward based not team-based

model • Projects on hold

7.4 Tier 3: Moderate community transmission

Governance Personnel Fever Clinic ICU

As per tier 1

As per Tier 2 As per Tier 0 plus: Increase staffing to fever clinic to

increase throughput Increase equipment to increase

throughput

Use of beds external to ICU (26 – HDU, PACU, Burns unit)

Maintain service for life threatening conditions

All available ventilation and alternative bed locations used

ED Inpatient COVID-19

As per Tier 0 plus: Consider use of fast track and cold for

extended respiratory section +14 (30)

As per Tier 2 plus: Consider 9AN and 9AS

(additional 60 beds) (118)

Meetings Training Service Operations Facility

As per Tier 2 Elective surgery: • Emergency Surgery only • Consider moving procedures to private

hospitals

As per Tier 2 plus: • Increase staffing ratios • Use of non-traditional bed

spaces • Consider visitor log

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Outpatient departments • Consider repurposing for Fast track

model of care to support ETC expansion

• This space may be required for pop up hospital ward – Needs to align to MNHHS plan for Private Hospital/other more appropriate clinical space

Pharmacy • Increase hours of operation weekends

and shifts • Change in ward pharmacist

requirements as per plan

• 24-hour Concierge • Consider screening at concierge ↑ cleaning

7.5 Clinical management for suspected, Probable or confirmed COVID-19 positive patient Rationalisation of patient contact to essential activities is paramount. Maximal use of phone/skype/video interactions should be used if physical examination is not required. The clinical spectrum of infection with COVID-19 ranges from mild disease with non-specific signs and symptoms of acute respiratory illness, to severe pneumonia with respiratory failure and septic shock. Deterioration, when it occurs, is often rapid, leaving little time for discussions around appropriate levels of care. The below outlines inpatient care principles:

For patients on the “critical care pathway” every attempt should be made to make this transition, should it be required, as smooth and predictable as possible.

Develop appropriate resuscitation plans

Detect and manage deterioration early, preferably in daylight hours

Avoid Medical Emergency Response Team (MERT) calls, emergency Intubation and resuscitation by early ICU review

For patients on the conservative pathway

Ensure adherence to the Advanced Health Directive (AHD) and avoid MERT calls

Proactive, supportive discussions with patients and families should include prognostic information, the potential for reversibility of symptoms and the potential burden of non-beneficial interventions. It will help to understand the patient’s values and preferences regarding life-sustaining interventions

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In such discussions avoid assumptions based on chronological age or incomplete understanding of health status. Careful consideration must be given to co-morbidities, underlying frailty, quality of life and anticipated lifespan when determining appropriate management.

Involve palliative care clinicians to help identify, triage and support patients in need of specialist palliative care management. This may include triaging patients who may benefit from transfer to a palliative care unit, transfer home (with palliative or home support if indicated), to another hospital or to an alternative care facility.

Involve GP’s, community services and outreach services as required.

Accelerate uptake of advance care planning among older at-risk populations in hospital, community settings and RACFs so that advance care plans stipulate circumstances where hospitalisation or aggressive life-support interventions in hospital would constitute forms of futile and inhumane care and unnecessary use of hospital beds.

For patients who are resident in a Residential Aged Care Facility (RACF):

Patients with confirmed or suspected COVID-19 who live in an RACF should in general be managed on a conservative pathway (see above). Every effort should be made by hospital outreach services (RADAR) and public health units to support RACF staff to provide isolation and care in the resident’s “home”.

“The Queensland ethical framework to guide clinical decision making in the COVID-19 pandemic” can be found at https://www.health.qld.gov.au/__data/assets/pdf_file/0025/955303/covid-19-ethical-framework.pdf This Framework supports clinical decision making and should be used by Metro North HHS staff to assist during the pandemic.

7.5.1.1 Reception Patients can present to RBWH at a number of locations including:

Onsite fever clinic – adjacent to ETC

Emergency and Trauma Centre - respiratory

7.5.1.2 Clinical Guidelines

Metro North HHS have enabled enhanced testing within our Hospital and Health Service to test beyond the suspect case definition (Refer to COVID-19 Enhanced Testing Policy for details)

7.5.1.2.1 Diagnostics for Reception Patients presenting to the Fever Clinics will be assessed for testing in accordance with the Communicable Diseases Network of Australia (CDNA) guidelines. Those who meet the current criteria will be tested with a single swab passed to the back of both the nose and the throat. The swab will be referred to the laboratory for testing labelled NCV-PCR. All patients who meet criteria and are subsequently tested are defined as “suspect cases” and should return home to self-isolation. It is important that clinicians in Fever Clinics ensure that this is viable prior to discharge. Alternate accommodation can be arranged via the local HEOC. Discharged patients must be informed that test results may take 48 hours and should be given literature describing their responsibilities as well as pathways to seek help while in isolation.

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COVID-19 is a notifiable disease. Following testing of the specimen, patients who are positive will be notified to both Metro North Public Health and also to the Metro North “Virtual Ward.” The patient will be contacted by both services – Public Health to serve an Enforceable “Public Health Order” to self-isolate and initiate contact tracing and the Virtual Ward to ensure ongoing care and early identification of deterioration. Patients who test negative for COVID-19 will be notified of this by Text message. It is important to note that patients must continue in isolation if they fulfil the criteria laid down by the Australian Government such as recent return from overseas.

7.5.1.3 Patient disposition MERT calls and emergency resuscitation carry a very high risk of staff contamination and infection. For this reason, every attempt should be made to eliminate this process from management.

• Minimising emergency resuscitation will entail: development of an Advanced Health Plan (AHP) for every patient on admission clarity of information within wards on every AHP available to staff 24/7

• early recognition of deterioration early placement in a single isolation room early consultation with ICU.

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For patients with comorbid disease, escalating or intensive care management of COVID-19 may necessitate communication on care decisions. This may include which therapies should be continued and which therapies should be paused or discontinued. Proactive, supportive discussions with patients and families should include prognostic information, the potential for reversibility of symptoms and the potential burden of non-beneficial interventions. It will help to understand the patient’s values and preferences regarding life-sustaining interventions. Palliative care clinicians should be involved to help identify, triage and support patients in need of specialist palliative care management.

7.5.1.4 Baseline for admission Patients with significant clinical symptoms requiring inpatient care should be admitted under full isolation precautions pending testing for both COVID-19 and a full respiratory screen. A decision to admit will depend on the clinical presentation, for example:

• mild to moderate symptoms – admit to low acuity care or virtual ward as appropriate major symptoms, altered vital signs, saturations <92% - admit to cohorted ward or single room Deteriorating vital signs, incipient respiratory failure – admit to ICU if appropriate

• The decision to either admit or manage via “virtual ward” will be made on a case-by-case basis, considering: the patient’s ability to engage in home monitoring the ability for safe isolation at home the risk of transmission in the patient’s home environment.

7.5.1.5 Virtual Care The Virtual Ward provides support for patients who are confirmed COVID-19 positive but are well and able to manage at home. The Virtual ED will be activated in Sustain Tier 2 response phase. The service is designed as an in-reach service for health professionals to have direct real-time consultations with ED clinicians regarding patients under their care. The service is a clinician to clinician consultation only. Targets clinicians are:

• GPs

• QAS

• Registered nurses at RACFs

• Clinicians from Residential Aged Care Assessment and Referral service (RADAR)

• Metro North Community Health clinicians.

7.5.1.6 PPE for staff It is expected staff will comply with standard precautions, including hand hygiene (5 Moments) for all patients with respiratory infections. In addition:

• patients and staff should observe cough etiquette and respiratory hygiene

• comply with transmission-based precautions for patients with suspected or confirmed COVID-19:

o contact and droplet precautions for routine care of patients

o contact and airborne precautions for aerosol generating procedures

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• if patient transfer outside the room is essential, the patient should wear a surgical mask during transfer and follow respiratory hygiene and cough etiquette.

For most inpatient contacts between healthcare staff and patients the following PPE is safe and appropriate and should be put on before entering the patient’s room. For hospitalised patients requiring frequent attendance by medical and nursing staff, a P2/N95 mask should be considered for prolonged or very close contact as per the guide for choosing PPE.

Droplet - Contact and Standard Precautions for Standard Care i.e.:

• surgical mask

• long sleeve impermeable gown

• gloves

• protective eyewear / face shield

Airborne - Contact and Standard Precautions for aerosol-generating procedures (for example, taking respiratory specimens, suctioning, intubation, nebulisers), patients with significant respiratory illness, or prolonged exposure (i.e. > 15 minutes face-to-face contact or in same room for > 2 hours).

• negative pressure room where possible

• P2 / N95 mask

• long sleeve impermeable gown

• gloves

• protective eyewear / face shield.

7.5.1.7 Diagnostics for patients admitted to hospital All patients admitted with suspected COVID-19 should have nasopharyngeal and oropharyngeal (throat) swabs performed (unless this has already been performed prior to the admission) by staff trained to properly perform these procedures in order to maximise the sensitivity of real-time PCR (RT-PCR) testing that is currently the diagnostic test of choice. RT-PCR testing has a turnaround time of 4 to 6 hours but can be significantly delayed by overload within the laboratory. Presentations with COVID-19 are often indistinguishable from other respiratory viruses so additional testing with a full “respiratory panel “is often appropriate. In patients with very recent onset of symptoms, RT-PCR tests may take up to 6 days to become positive, and hence the sensitivity of the initial test may be no more than 70%. Repeat testing at 24 and 48 hours is reasonable in patients with risk factors and/or suggestive clinical features and/or non-response to effective antibiotics in cases of atypical pneumonia where other pathogens have been excluded. In patients who already have lower respiratory tract infection and have a productive cough, after they have rinsed their mouth with water, a deep cough sputum sample should also be expectorated directly into a sterile container. A serology specimen should be collected during the acute phase of the illness (preferably within the first 7 days of symptom onset), stored, and when serology testing becomes available, tested in parallel with convalescent sera collected 3 or more weeks after acute infection.

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Viral cultures and serological tests have no utility in acute diagnosis and should not be requested.

7.5.1.8 Clearances Patients must be free of symptoms including fever for 72 hours prior to clearance. There is no requirement for additional testing. Refer to CDNA SoNG for latest updates. Coronavirus Disease 2019 (COVID-19) CDNA National guidelines for public health units: https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm

7.5.1.9 Digital resources The following digital resources are available:

• Syndromic activity board – COVID-19

• COVID-19 dashboard – provides the following data elements:

o total ILI presentation as proportion of total presentations

o ILI presentation via ED per discharge disposition

o SSU admitted, D/C or Transferred

o ILI presentations by Geographic distribution

o age group distribution.

• COVID-19 intranet site https://qheps.health.qld.gov.au/metronorth/flu

• Alerts in Patient Flow Manager and Wardview for COVID-19 positive patients

• Incoming Passenger app – supports screening and registration of people at any Brisbane airport.

• DcoVA –enables statewide registration of patients with COVID-19, and support management of patients under Public Health Orders (PHOs). It has a direct feed from AUSLAB for COVID-19 results and there is further potential for natural language processing of medical imaging results.

• Virtual care digital resources - https://qheps.health.qld.gov.au/metronorth/digital-metro-north/virtual-care

7.5.2 Resource management

7.5.2.1 PPE stockpiles and clinical consumables RBWH monitors PPE stockpiles and clinical consumables to determine and ensure appropriate stock levels are available to support BAU as well as expected surge. The provision of PPE most focus foremost on staff but is also required for patients and visitors in certain circumstances. PPE appropriate for COVID-19 includes:

• disposable gloves

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• long sleeve gowns

• goggles

• surgical/N95 masks and

• alcohol hand gel.

PPE is available and placed at the entrances/triage desks within all publicly accessible areas – particularly in ICU, Emergency Departments and wards being used to accommodate COVID-19 patients. Clinical consumables notable for management of COVID-19 include flocked swabs for viral polymerase chain reaction.

7.5.2.2 Operational support Environmental cleaning of patient care areas: • Cleaners should observe contact and droplet precautions signage

• Environmental cleaning and disinfection of infection control areas will occur in line with current Queensland Health and Metro North HHS Guidelines

• Frequently touched surfaces such as doorknobs, bedrails, tabletops, light switches, patient handsets in clinical areas and patient room should be cleaned daily

• Frequently touched surfaces such as doorknobs, bedrails, tabletops, light switches, patient handsets in non-clinical areas will be cleaned more frequently

• Perform terminal cleaning of all surfaces (as above plus floor, ceiling, walls, blinds) after a patient is discharged

• A combined cleaning and disinfection procedure should be used; this is either

– 2-step - detergent clean, followed by disinfectant; or

– 2-in-1 step - using a product that has both cleaning and disinfectant properties.

• Any hospital-grade, TGA-listed disinfectant that is commonly used against norovirus is suitable, if used according to manufacturer’s instructions.

7.6 Human resources The health, safety and wellbeing of all healthcare workers is a priority for Metro North HHS. A staff management portfolio has been established which will manage and monitor the reallocation of staff, ensuring allocation to priority areas and matching of skillsets. A survey to identify staff able and willing to be reallocated has been conducted and distributed to the Directorates. Directorates staff management team/coordinator will manage staff within their Directorates and access Metro North team as required. A wellbeing strategy is being implemented with the aim to ensure staff feel supported and that their wellbeing is at the forefront of everything we do during the pandemic. A wellbeing executive has been appointed to oversee and manage staff wellbeing during this time. This strategy links staff to available resources and tools to assess and support their wellbeing. A peer support line to provide psychiatrist led support to medical specialists working in ICU, Emergency departments, respiratory wards and the anaesthetists has also been established.

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7.6.1.1 Staff management A range of strategies to ensure adequate workforce are available during the pandemic will be implemented in line with the tiered response including:

new rostering models

recruiting retired or semi-retired clinicians

reassigning healthcare workers out of their usual work area

utilising healthcare students as assistants

reviewing scope of practice

increasing casual pools and temporary staff

increasing hours of part time staff on voluntary basis

active leave management including absenteeism and fatigue

accelerated recruitment processes.

7.6.1.2 Managing ill workers Ill or quarantined workforce will be managed in line with the Queensland Health Human Resources Guidelines available on the intranet. Refer to section 7.2.1.1 for details on managing vulnerable workforce. Leave, Returning and returning to work

Different leave types, either paid or unpaid, may be granted to employees directly affected by this event. Refer to the MNHHS COVID-19 Virus Pandemic Factsheet for information regarding specific leave options.

Quarantine

All Metro North HHS staff impacted by isolation / quarantine must be registered with the Metro North HHS Emergency Operations Centre via [email protected].

7.6.1.3 Staff wellbeing strategy

The Metro North Wellbeing Strategy – COVID-19 covers the emotional, financial, physical and social domains of wellbeing.

Metro North’s values of compassion, integrity, respect, teamwork and high performance form the foundation of decisions and actions relating to the wellbeing strategy during COVID-19. The position of Chief Wellbeing Officer is accountable for the strategy.

The aims of the strategy are to ensure staff feel supported and have their wellbeing considered, link to existing resources and provide access to new initiatives tailored to COVID-19.

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New initiatives include:

COVID-19 HR hotline

Peer responder program to provide psychological first aid

RUOKstaff to provide a collegiate support network

COVID Staff Psychology Support – a tailored onsite counselling service for any employee who has increased risk to their mental wellbeing resulting from working directly with COVID-19 patients

Profession focussed support and initiatives are outlined in the Metro North Wellbeing Strategy as well as professional association support included below:

Medical Professional Association Support

Nursing Professional Association Support

Allied Health Professional Association Support

Metro North’s Employee Assistance Service (EAS) provider Benestar is offering expanded support as part of the Staff Wellbeing Strategy.

7.6.1.4 Industrial relations Engagement with the various unions will occur throughout the pandemic.

7.6.1.5 Reallocation

Metro North HHS may be required to reallocate staff in response to the COVID-19 activities. These reasons could include (but are not limited to) are:

vulnerable staff that are unable to be reallocated within their own teams,

service changes including reduction or closure of services,

reduction in workload due to business focus changes.

A range of resources are published on the Metro North extranet page, that support the process of staff reallocation ensuring a streamlined approach. Resources include:

Orientation Handbook has been developed to support reallocated (deployed) staff. All reallocated (deployed) staff are required to complete the Orientation Handbook to comply with Workplace Health and Safety, patient safety and scope of practice requirements.

Checklist to support reallocation of Metro North workforce during COVID-29 pandemic

A Nursing and Midwifery factsheet has been developed to assist nursing and midwifery decision-making in respect to Scope of Practice, Reallocation and Deployment of nurses and midwives during a COVID 19 pandemic response.

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A central process will prioritise and manage the reallocation of staff across the HHS. Each Directorate has a workforce unit to coordinate this locally, with central oversight by Metro North Executive.

The Directorate Workforce Coordinators (DWC’s) are supported by the Metro North Emergency Operations Centre (EOC) Logistics – Workforce team to assist and support the reallocation process of employees.

7.6.1.6 Workplace health and safety

Workplace health and safety precautions are being taken in line with the Chief Health Officers advice. Public Health surveillance, rapid response teams and case investigation will be available. A range of COVID-19 specific health and safety checklists and factsheets have been developed on local induction, workplace injuries (for employees and line managers), QSuper, Workcover and related to management of uniform/clothing for staff working with patients suspected or positive for COVID-19.

7.6.1.7 Recruitment and onboarding All Staff Orientation for COVID-19 has been described in a factsheet and will be delivered to each new starter as an online module. During the COVID-19 emergency response period any new starter joining Metro North will still need to undertake their mandatory training. These will be assigned to them in the Metro North Learning Management System (LMS) as per the Policy. This will include the new Metro North Orientation module. The information provided on the Mandatory Training page outlines legislative and mandatory training requirements, standards and assessments, including the frequency of training that must be completed to enable a safe working environment for everyone, including our patients and consumers.

7.6.1.8 Fatigue Management Management of Fatigue across MNHHS occurs in accordance with the MNHHS Fatigue Risk Management Procedure and the Department of Health Fatigue Risk Management Policy I1 (QH-POL-171). A summary document has been developed which outlines the general management of fatigue. Specific guidelines for relating to fatigue risk management for Medical and Nursing and Midwifery professional streams has also been developed.

7.7 Aboriginal and Torres Strait Islander people All Aboriginal and/or Torres Strait Islander peoples are considered part of a vulnerable group when considering ILI and COVID-19. Practitioners should assess all Aboriginal and/or Torres Strait Islander peoples presenting with ILI for chronic diseases and other risk factors. Health professionals should keep the following points in mind when assessing and treating any patients who may have COVID-19.

• Need to actively identify Indigenous person of Aboriginal and/or Torres Strait Islander origin.

• The high prevalence of chronic disease in Aboriginal and/or Torres Strait Islander populations that may predispose to severe outcomes.

• The social circumstances and needs of patients that are identified as Aboriginal and/or Torres Strait Islander origin.

• The possibility that the patient may be residing with a person who is vulnerable, for example, due to the presence of chronic disease(s).

• Would the patient benefit from support by the Indigenous Hospital Liaison Officer?

• Is the information provided in a culturally appropriate manner, so that the patient, contacts and community understand the information by using culturally specific posters, brochures and pamphlets?

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Resources to support HHS’s to address the COVID-19 needs of the First Nations Queenslanders are available online at https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/information-for/first-nations. These resources include:

• COVID-19 Preparing for your community: Information for Mayors 16 March 2020.

• COVID-19 HHS preparedness checklist for Queensland’s First Nations people. 16 March 2020.

• COVID-19 Protection and Containment Considerations for First Nations Communities: Information Resource. 25 March 2020.

• Attachment 1: Community and health service action checklist (as at 25 March 2020).

• Attachment 3: Intersection of community and HHS COVID-19 planning

• Fact Sheet Cleaning of quarantine accommodation in First Nations communities.

• A range of screensavers, hospital posters and fact sheets for hospitals and for the Hospital and Health Service.

Challenges to infection control in Aboriginal and/or Torres Strait Islander communities are acknowledged. As such, isolating cases from those who are more vulnerable to severe outcomes and recommending keeping a distance of one metre from others may be a more manageable approach to preventing spread of disease.

• The voluntary home isolation of patients with infection is strongly recommended to reduce transmission but consideration must be given to who else is at home.

• Other measures such as patients using masks can be considered depending on the vulnerability of contacts and living circumstances.

• Information about hand hygiene (Hand washing and drying) and cough etiquette should be promoted to patients, contacts and community and are explained in a culturally appropriate manner.

There are a suite of culturally specific resources for COVID-19 on the Extranet Metro North Hospital and Health Service webpage and also the Australian Government Aboriginal and Torres Strait Islander Advisory Group on COVID-19 communiques.

7.8 Vulnerable groups Communities and individuals identified as being vulnerable, and in which mortality and morbidity is expected to be higher, include people with complex and chronic disease, culturally and linguistically diverse people, older persons and persons in residential aged care.

7.8.1 People with Mental illness The Chief Psychiatrist has also made a temporary amendment to the Mental Health Act during this time. Details of the amendment can be found https://qheps.health.qld.gov.au/mentalhealth/mha/mha/mha2016-covid-19 (available internal to QH only).

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The Queensland government through the Department of Housing and Public works has made available $24.7mil for COVID-19 responses in housing and homelessness. The Queensland Department of Housing and Public Works has contracted Q Shelter to lead the 12-month Queensland Service Integration Initiative in providing a state-wide backbone support role to nine priority locations. The initiative involves strengthening front-line care coordination groups responding to homelessness and housing need. The locations in Metro North are Moreton and Brisbane. This initiative aims to build capacity for integrated, front-line responses to people with multiple needs who are homeless, or at risk of homelessness. The care coordination groups will also play their part in strengthening regional responses to COVID-19.

7.8.2 People with disabilities Resources for people with disabilities are available at https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/information-for/people-with-disability-and-carers. In addition the NDIS and other organisations have also developed resources available on their websites.

7.8.3 Residential aged care residents Residential aged care facilities (RACFs) increased advanced care planning and pandemic planning with virtual services to increase support to RACFs and reduce physical outreach have been established. A Brisbane Metro COVID-19 Outbreak Response Plan with clear guidelines on the management in RACFs should there be a COVID-19 outbreak.

7.9 Financial management Cost identification and capture processes are to be captured in incident response cost centres in Directorates (one for screening and indirect costs and one for direct costs of patient care). Costs will be collected by directorates (including supporting documentation) and claimed by Metro North HHS via DoH. Funding (to offset actual expense) will be accrued at end of month by Health Funding and Data Insights team. This will be allocated to directorate level against incident cost centres. Adjustments have been made to monthly performance reports to identify incident related costs. COVID-19 is expected to have a negative impact on total Weighted Activity Units (WAUs) for Metro North HHS. Baseline performance metrics have been collated for key metrics and the impact of these have been modelled in line with escalation of activity in line with the response plan. Selected staff have been issued with emergency corporate credit cards to be used for identified Emergency Events. The financial delegation matrix in S/4 has been updated to ensure that online orders against emergency event cost centres will workflow to appropriate delegates. Additional financial delegates have been identified at each facility.

7.9.1 Medicare ineligible patients All patients are to receive the required testing and treatment irrespective if they are Medicare eligible or ineligible. The provision of commonwealth funding under the National Partnership Agreement with the States will be at 50 per cent of the costs to provide testing, housing or treatment of all patients.

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7.9.2 Activity capture

COVID -19 Data Definitions For purpose of reporting and operational response.1

Metric Definition

Confirmed case (Communicable Diseases Network Austraila, 2020) any person with a positive laboratory test for COVID-19

Probable (Communicable Diseases Network Austraila, 2020)

without positive laboratory test but which is treated like a confirmed case based on exposure history and clinical symptoms

Suspected (Communicable Diseases Network Austraila, 2020)

without positive laboratory test but which is treated like a confirmed case based on clinical symptoms and epidemiological criteria

Active Case (Communicable Diseases Network Austraila, 2020)

Confirmed case, that has not recovered or died. Active does not mean that these cases are infectious

Cleared -Admitted Virtual Ward Confirmed Case that are at least 10 days since onset and have not exhibited symptoms for 72 hrs, and have been cleared by the health professional responsible for their monitoring

Cleared - Admitted -Acute Bed (incl ICU) Confirmed Case that are at least 10 days since onset and have not exhibited symptoms for 72hrs, with 2 negative test result a minimum of 7 days after onset of symptoms

Total Recovered (Queensland Health, 2020)

“Recovered cases are cases reported as recovered by the responsible Public Health Unit plus cases that have a notification date of 30 days or more”

COVID -19 death (Communicable Diseases Network Austraila, 2020)

death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative to cause of death that cannot be related to COVID-19 (e.g. trauma)

Significant cluster there are ten or more cases connected through transmission and who are not all part of the same household - includes both confirmed and probable cases.

Enhanced Testing (Communicable Diseases Network Austraila, 2020)

testing beyond suspect case definition

1 Queensland Government COVID-19 statistics; Coronavirus Disease 2019 (COVID-19) CDNA National Guidelines for Public Health Units (13/05/2020)

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Inpatient activity To be sourced via Digital Metro North (DMN) data set– based on matching pathology results with inpatient data. Retrospective capture of information / patients to be achieved through coded patient information and application of specific COVID 19 ICD code.

ED activity To be sourced via DMN data set based on reporting flags within EDIS. Existing dashboards and reporting frameworks to be updated to incorporate.

Outpatient activity Initial screening activity to be sourced via EOC (manual data collection at this stage) and information collated by HFDI for reporting.

• COVID19 Tier 2 clinic code has been issued and business rules issued to support its use.

• DNA - Likely to utilised specific reason codes for DNAs across all sites.

• DoH advice / guidelines received and provided to directorates.

• Fever clinics - Likely to be scheduled / registered using local tool (eg. ESM, HBCIS, HCare or EDIS).

Outpatients Tier 2 clinic cancellation codes Two new cancellation codes have been created in the HBCIS APP Module to accurately reflect reasons for appointment cancellations relating to COVID-19. These codes are:

Cancellation Code Description Start Date 31 Pub Health Alert Pt Initiated 05 MAR 2020 32 Pub Health Alert Hosp Initiated 05 MAR 2020

7.10 Private Hospitals On 1 April 2020 an agreement was reached between the Commonwealth and private hospitals to support delivery of health services during the pandemic. Queensland Department of Health has subsequently signed an Agreement with private providers setting out all contractual arrangements. Metro North HHS has a framework and operational guidelines to support our interaction with the private facilities in the HHS to explore what services, equipment and resources they could assist with.

8 Control The Control Phase will be characterised by a vaccine being widely available and the pandemic beginning to be brought under control demonstrated through decreasing pandemic activity, whilst there is uncertainty if additional waves will occur. The focus during this phase is to:

• evaluate the response – what did we stop, what did we start, what did we do differently (clinical and non-clinical and corporate activities)

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• determine recovery strategies – what do we continue, what do we stop and when, what do we restart and when, what needs to be “caught up”

• prepare for a possible second wave

• undertake a range of monitoring and compliance activities associated with relaxations of restrictions.

Upon reaching control phase, Metro North HHS will evaluate the effectiveness of the innovative models that have been developed to manage the pandemic to determine what models should be incorporated into the new normal business environment. Metro North HHS will adopt a phased approach for resuming business activities and determining strategies to assist with “catching up” where necessary.

9 Recover The Recovery Phase is characterised by the pandemic being under control in Australia however further waves may occur if the virus drifts and/or is reimported into Australia. During this phase there is ongoing evaluation of the response, revision of plans and activation of recovery strategies. The Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) outlines activities associated with this phase including:

• support and maintain quality care

• cease activities that are no longer needed, and transition activities to normal business or interim arrangements

• monitor for a second wave of the outbreak

• monitor for the development of resistance to any pharmaceutical measures

• communicate to support the return from emergency response to normal business services

• evaluate systems and responses and revise plans and procedures.

Metro North will work with other government agencies to consider whether the community require additional services to enable full psychological, social, economic, environmental and physical recovery from the effects of the COVID-19 outbreak. At-risk groups may need additional support. Analysis of available data to evaluate the epidemiological, clinical and virological characteristics of the pandemic will be undertaken and ongoing surveillance measures will be considered and incorporated. Newly developed policies and procedures will be reviewed to determine their ongoing applicability and be updated accordingly.

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Appendix 1: RBWH COVID-19 Committee list Meeting Contact Daily IMT briefing meeting (Monday to Friday) - IMT [email protected] Daily IMT Summary meeting (Monday to Friday) – hospital network [email protected]

Appendix 2: Infrastructure at Tier level

RBWH Fever Clinic capacity ED Spaces ICU Beds Isolation Room Beds^

Tier 1 200 12 36

Tier 2 600 16 54

Tier 3 600 30 80

^Capacity for COVID-19 positive patients